Nifuroxazide-induced acute pancreatitis: a new side-effect for an old drug?

We report the case of a middle-aged woman who developed a typical picture of acute pancreatitis together with systemic features of immunoallergy after the intake of two capsules (200 mg) of nifuroxazide. Even if acute pancreatitis is a rare adverse event of nitrofuran derivative therapy, nifuroxazide-induced pancreatitis as not been previously described. As suggested by associated systemic features, the disease is likely of immunoallergic origin.     

Spleen:A new role ffoorr an old player?

The spleen could be considered a neglected organ.To date,it has been deemed an ancillary organ in portal hypertension or an organ localization in lymphoproliferative diseases,even though it has had significant attention in infectious diseases for some time.Now,it is thought to be central in regulating the immune system,a metabolic asset and involved in endocrine function with regard to nonalcoholic fatty liver disease.The main mechanisms involved in this complex network will be critically discussed in this ...     

Folie à deux: an old diagnosis with a new technology

The implantable cardioverter defibrillator (ICD) is the treatment of choice for life-threatening ventricular tachyarrhythmias. Despite this, indications for explantation have been described. Psychiatric complications have been considered in the decision to not re-implant a previously explanted device but never as a primary indication for explantation. The case of a woman who requested ICD explantation amidst concerns that the titanium used in its construction was absorbing harmful negative electromagnetic field energy from the environment resulting in intermittent bouts of fatigue, diaphoresis and an overall sense of impending doom is presented. She and her husband had significant psychosocial impairment because of this belief system. The present case is the first known report of a psychiatric complication as the primary indication for ICD explantation. It is illustrative of diagnostic dilemmas, competency and the importance of quality of life.     

Calcific aortic stenosis: same old story?

Calcific aortic stenosis is the commonest adult valvular heart condition seen in the western world. Its prevalence is continuing to rise, with predominance in older patients who are frequently undergoing successful aortic valve replacement. This review discusses the natural history of calcific aortic stenosis, highlights recent insights into its pathogenesis, and outlines current medical and surgical management. The potential role of novel therapeutic interventional strategies is discussed.     

Convalescent plasma: new evidence for an old therapeutic tool?

Passive immunisation for the prevention and treatment of human infectious diseases can be traced back to the 20^th century. The recent Ebola virus outbreak in West Africa has turned the spotlight onto the possible use of convalescent whole blood and convalescent plasma in the treatment of infectious diseases because they are the only therapeutic strategy available in some cases, given the unavailability of vaccines, drugs or other specific treatments. Convalescent blood products could be a valid option in the treatment/prophylaxis of several infectious diseases both in association with other drugs/preventive measures and as the only therapy when a specific treatment is not available. However, there are still some issues to consider in determining the advisability of implementing a large-scale convalescent plasma transfusion programme.     

The grapefruit: an old wine in a new glass? Metabolic and cardiovascular perspectives

Grapefruit is a popular, tasty and nutritive fruit enjoyed globally. Biomedical evidence in the last 10 years has, however, shown that consumption of grapefruit or its juice is associated with drug interactions, which, in some cases, have been fatal. Grapefruit-induced drug interactions are unique in that the cytochrome P450 enzyme CYP3A4, which metabolises over 60% of commonly prescribed drugs as well as other drug transporter proteins such as P-glycoprotein and organic cation transporter proteins, which are all expressed in the intestines, are involved. However, the extent to which grapefruit-drug interactions impact on clinical settings has not been fully determined, probably because many cases are not reported. It has recently emerged that grapefruit, by virtue of its rich flavonoid content, is beneficial in the management of degenerative diseases such as diabetes and cardiovascular disorders. This potentially explosive subject is reviewed here.     

Adriamycin-induced myocardial toxicity: new solutions for an old problem?

Adriamycin is a potent and broad-spectrum antineoplastic agent that plays a major role in cancer chemotherapy. Unfortunately, its use has been hampered by conventional toxicities and cardiotoxicity manifested by congestive cardiomyopathy. Adriamycin is particularly toxic to heart tissue and constitutes a major cause of morbidity and mortality due to its complex pathogenesis. In this review, the different forms of cardiotoxicity produced by adriamycin as well as the biochemical changes induced by this drug are summarized. Secondly, the current hypotheses proposed to explain adriamycin-induced myocardial damage (the iron and free-radical hypothesis, the metabolic hypothesis, the "unifying hypothesis" and apoptosis) and the attempts to reduce adriamycin-induced myocardial toxicity are discussed (e.g. dose limitation, close cardiac monitoring, alteration of dosage schedules, development of new anthracycline analogs, and the administration of protective agents and liposomal encapsulation). Finally, we summarized our own experimental and clinical experience in ameliorating and or preventing adriamycin-induced cardiotoxicity and the latest attempts to prevent and/or monitor cardiac function. According to this, a combination of usual doses of calcium antagonist drugs plus vitamins A and E seems advisable.     

Central venous pressure: an old lady in new clothes?

Invasive haemodynamic monitoring plays a pivotal role in critically ill patients. In this respect, central venous pressure is one of the most often used parameters. This review aims to provide an overview of the use of central venous pressure monitoring, the advantages and shortcomings, besides pitfalls. The integration of central venous pressure monitoring into other haemodynamic monitoring is discussed.     

Methotrexate in Crohn’s disease: a new face for an old drug?

Introduction: Methotrexate is commonly used in rheumatoid arthritis but randomised controlled trials demonstrated its efficacy also in Crohn’s disease. Methotrexate, although marginally used in clinical practice, is considered an appropriate immunomodulator particularly in patients refractory or intolerant to thiopurines.

Areas covered: A literature search using ‘methotrexate’, ‘Crohn’s disease’ and ‘Inflammatory Bowel Disease’ as key words, identified randomised controlled trials, meta-analyses and observational studies. The aim of this review is to summarise and critically discuss the available evidence concerning the efficacy and safety of methotrexate in the treatment of Crohn’s disease.

Expert commentary: Methotrexate is effective in inducing and maintaining remission in steroid-dependent CD at a dose of 25 mg/week and 15 mg/week, respectively. Data from observational studies suggest that methotrexate may be as efficacious as thiopurines with a similar safety profile. In specific clinical settings, (patients with a history of malignancy or young Epstein-Barr Virus–seronegative patients), methotrexate compete favourably with thiopurines.